|What Is An Abortion?
An abortion is the termination of a pregnancy before the embryo or fetus can live independently. Doctors refer to a miscarriage - the involuntary spontaneous loss of a pregnancy - as an abortion (or natural abortion). But for most non-medical people, the term is used to describe a procedure that brings about the end of a pregnancy. About 1 million terminations are performed every year in the United States and it is estimated that nearly 50 percent of all American women will have had an abortion by the time they reach the age of 45.
Are Abortions Legal?
Yes, abortions have been legal in the United States since 1973. However there are some differences in state law. Under the Constitution all women are entitled to an abortion at any time in the first trimester of pregnancy (first 13 weeks). In the second trimester individual states have the right to determine where and by whom abortions can be performed. More than 95 percent of abortions are performed in the first trimester, when the procedure is much safer. But there are a number of reasons why some women delay until the second trimester. Some may not realize they are pregnant, this is particularly true for teenage girls whose periods may not yet be regular or for women using birth control methods like the IUD device which is considered highly effective. It is not uncommon for teenagers to delay telling their parents about their pregnancy in the irrational hope that things will somehow sort themselves out. Furthermore nearly 60 percent of women who delay in obtaining an abortion cite the time it took to make arrangements and raise the money. Whatever the reason for a delay, second trimester abortions are more difficult and costly to perform.
Can I Have An Abortion Without My Parents Knowing?
18 percent of American women who have abortions are teenagers. 6 percent are aged between 15 and 17 and 11 percent are aged between 18 and 19. Less than 1 percent are younger than 15. The laws on abortions for teenagers under the age of 18 differ from state to state. Some states require parental permission if you are 17 or under, although a judge can help you bypass this with a process called Judicial Bypass. Other states require you to wait 24 hours after speaking to a clinic counselor or doctor before having a termination. State examples: In Texas the law requires that one parent is told (permission is not necessary, they just need to be told) 48 hours before the abortion. There is Judicial Bypass. In New York, New Hampshire, Montana and Connecticut, no permission is necessary. Studies show that even without specific parental involvement laws, 6 in every 10 minors still chose to inform at least one parent.
How Are First Trimester Abortions Performed?
There are several different methods of performing an abortion in the first 13 weeks of pregnancy - they can be performed between weeks 5 and 13. Usually they involve surgery to widen (dilate) the cervix and remove the contents of the womb. Which procedure is used depends on how far the pregnancy has progressed. Progression is measured in gestational age. This figure is derived from the number of weeks that have passed since your last menstrual period (which is about 2 weeks before fertilization). This means, if you are one week late getting your period, you would be considered 5 weeks pregnant.
Weeks 5 to 7: Options include surgical menstrual extraction or medication (abortion pill).
Weeks 8 to 9: Abortion pill is an option until week 9.
After week 6 or 7: Dilation and evacuation.
Also called: Miniabortion, minisuction and menstrual regulation.
Between weeks 5 and 7 the contents of the womb can be sucked out without the need to dilate the cervix. This procedure can be carried out in a doctor's office by a doctor. A flexible tube is inserted through the cervix and into the womb. The contents are sucked out with a vacuum or small pump. Sometimes the procedure is called a preemptive abortion if it is performed before pregnancy has been confirmed. It only takes a few minutes and requires no anesthesia. While it is safer than procedures performed later in pregnancy, menstrual extraction has a high risk of failure. Failures occur because there is very little fetal tissue in the first few weeks of pregnancy and it may be easily missed. Although it is understandably tempting to terminate a pregnancy as soon as possible (if that is the desired outcome), it could be wiser to wait another week or two and opt for dilation and evacuation. If you have a menstrual extraction, you should have a follow up blood test 2 weeks later to check if you are still pregnant.
Dilation And Evacuation (D&E)
Also called vacuum aspiration, vacuum curettage, suction D&C and suction curettage.
After week 6 or 7 the cervix will need to be dilated in order to empty the womb. It usually requires local or regional anesthesia and is performed on a day-basis (no overnight stay necessary). The cervix needs to be dilated more than for a traditional dilation and curettage (D&C). This is sometimes done with laminaria - long rods with kelp that absorb moisture - they are inserted into the cervix 2 to 24 hours before the procedure to dilate it slowly. Once dilated, a vacuum machine is inserted into the cervix and suction is applied to remove the fetus and placenta. A curette is then used to scrap out any remaining tissue. The procedure takes about 20 to 45 minutes. The level of pain experienced during the suction process varies from woman to woman - depending on their individual pain threshold and on their personal feelings about the abortion. You may be prescribed a tranquilizer beforehand to reduce your anxiety. After you will be placed in a daycare room where you can be monitored for an hour before going home.
Also called medical abortions or nonsurgical abortions.
Mifepristone (RU-486, brand name Mifeprex) is the only drug currently licensed by the FDA to terminate a pregnancy. It works by blocking the effects of progesterone hormones, making it impossible for the fertilized egg to implant in the womb. To be effective it needs to be taken before the 9th week after the start of the last menstrual period. So for example, if your period is two weeks late - and your last period was 4 weeks before that, then you are considered 6 weeks pregnant. Mifepristone is a tablet and should only be taken in a clinic under medical supervision. You take 3 tablets together on the first day. Two days later you go back to your doctor. If he is not sure if the pregnancy has ended you will be given misoprostol (an anti ulcer drug that induces cramping and bleeding). You may experience vaginal bleeding for 9 to 30 days. Two weeks later you should return to your doctor for an ultrasound scan to ensure the termination of pregnancy. Occasionally Mifepristone is used as an emergency contraception (morning after pill), or to treat uterine fibroids, brain tumors, endometriosis or to induce labor in a pregnant woman.
How Are Second Trimester Abortions Performed?
A second trimester abortion is a termination carried out between weeks 14 and 24. With the growing number of women undergoing genetic testing during pregnancy and the increasing amount of women becoming pregnant after 35 - increasing numbers of women are choosing to terminate when results from amniocentesis or ultrasound indicate fetal abnormalities. Terminating at later stages can be particularly painful (emotionally) because the mother may have bonded with her baby and felt him/her kick. In some hospitals she may need to undergo an abortion is the same room as women experiencing full-term births.
There are basically two options for second trimester abortions: late D&E or labor induction.
For some women a late D&E after week 16 is not an option. It may be that she cannot find a doctor who will perform it (either because the doctor does not have the necessary training or has personal objections). Many women are unaware (because they are not offered the choice) that there are doctors who safely perform late D&E's until week 23 of gestation. However, even if a doctor were available, some women are still uncomfortable with the thought of a late D&E. For example, if a woman chooses to terminate because she has been told that her baby has a birth defect, the thought of having the fetus dismembered during a D&E may be too traumatic. By choosing labor induction, the fetus is 'born' intact.
A late D&E is essentially the same as an early D&E, but it takes longer to perform. It requires a lot more skill on the part of the surgeon because there is more fetal tissue to remove, the womb is larger and easier to injure, and larger tools are required. A general anesthesia is usually given.
Overnight hospital stay may be required but most facilities allow women to go home on the same day. The day before the procedure you will need to visit the doctor so that laminaria rods can be inserted to speed up labor (labor induction). On the day of induction a variety of drugs (saline, prostaglandin or less often urea) is injected into the amniotic sac to start uterine contractions. The saline causes the death of the fetus, although there is a slight risk if it enters the blood vessels that it could cause shock and even death. Contractions generally begin within a few hours and are milder than those of full-term labor. An epidural or other pain relief medications may still be offered. It takes on average 8 hours but can take up to 72 hours for delivery. Once the fetus and placenta is delivered, a D&E will be necessary to remove any remaining tissue. A few hours later you should be able to go home.
When To Call The Doctor
If you have had an abortion, call the doctor if you have any of the following signs. They may indicate an infection or other complication:
• A fever over 100 F
• Excessive vaginal bleeding (soaking a pad every 1 or 2 hours or passing large clots).
• An increase in bleeding over 2 days.
• Severe and persistent tummy pain.
• Foul smelling vaginal discharge.
• Vomiting or fainting.
• Symptoms of pregnancy that last longer than a week.
How Much Do Abortions Cost?
The cost depends on the stage of pregnancy and which clinic provides the service. The average cost of a first trimester termination is about $500. Second trimester procedures range from $600 to as much as $10,000. Many insurance plans cover abortion. State Medicaid cover varies from state to state.
American Abortion Statistics
Talk to your doctor about taking contraceptive pills or another suitable form of birth control. Read about contraceptive pills side effects if you are considering this option. Other options (if you find it difficult to remember taking a pill) include birth control implants such as Implanon and birth control injections like Depo-Provera.
• The number of abortions performed every year in America has dropped 25 percent in the past decade.
• 88 percent are performed in the first 12 weeks, and 62 percent within the first 8 weeks.
• Major complications were only reported in 0.3 percent of abortions.
• The cost of an abortion depends on what stage it is performed. The average cost at 10 weeks gestation is $451.
• 54 percent of women who have an abortion report using contraception during the month they became pregnant.
• Each year about 10,000 to 15,000 abortions occur in women who whose pregnancies resulted from incest or rape.
• The highest rates of abortion are reported in Delaware (40 percent) and New York (38 percent) and the lowest in Wyoming (less than 1 percent) and Kentucky (5 percent).
Source: The American Congress of Obstetricians and Gynecologists